Healthcare Provider Details

I. General information

NPI: 1023563244
Provider Name (Legal Business Name): JACQUELINE OBADO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2016
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 E 63RD ST APT 1D
NEW YORK NY
10065-7928
US

IV. Provider business mailing address

450 E 63RD ST APT 1D
NEW YORK NY
10065-7928
US

V. Phone/Fax

Practice location:
  • Phone: 646-309-0566
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number702511
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: